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State of the art review
Intensive care unit interventions to promote sleep and circadian biology in reducing incident delirium: a scoping review
  1. M Elizabeth Wilcox1,
  2. Lisa Burry2,3,
  3. Marina Englesakis4,
  4. Briar Coman5,
  5. Marietou Daou5,
  6. Frank MP van Haren6,7,8,
  7. E Wes Ely9,10,11,
  8. Karen J Bosma12,13,14,
  9. Melissa P Knauert15
  1. 1 Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Department of Pharmacy, Sinai Health System, Toronto, Ontario, Canada
  3. 3 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
  4. 4 Library and Information Services, University Health Network, Toronto, Ontario, Canada
  5. 5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
  6. 6 School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
  7. 7 University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
  8. 8 Intensive Care Unit, St George Hospital, Sydney, New South Wales, Australia
  9. 9 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  10. 10 Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
  11. 11 Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Health Care System, Nashville, TN, USA
  12. 12 Department of Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
  13. 13 Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
  14. 14 Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
  15. 15 Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Melissa P Knauert; melissa.knauert{at}yale.edu

Abstract

Rationale/Objectives Despite plausible pathophysiological mechanisms, research is needed to confirm the relationship between sleep, circadian rhythm and delirium in patients admitted to the intensive care unit (ICU). The objective of this review is to summarise existing studies promoting, in whole or in part, the normalisation of sleep and circadian biology and their impact on the incidence, prevalence, duration and/or severity of delirium in ICU.

Methods A sensitive search of electronic databases and conference proceedings was completed in March 2023. Inclusion criteria were English-language studies of any design that evaluated in-ICU non-pharmacological, pharmacological or mixed intervention strategies for promoting sleep or circadian biology and their association with delirium, as assessed at least daily. Data were extracted and independently verified.

Results Of 7886 citations, we included 50 articles. Commonly evaluated interventions include care bundles (n=20), regulation or administration of light therapy (n=5), eye masks and/or earplugs (n=5), one nursing care-focused intervention and pharmacological intervention (eg, melatonin and ramelteon; n=19). The association between these interventions and incident delirium or severity of delirium was mixed. As multiple interventions were incorporated in included studies of care bundles and given that there was variable reporting of compliance with individual elements, identifying which components might have an impact on delirium is challenging.

Conclusions This scoping review summarises the existing literature as it relates to ICU sleep and circadian disruption (SCD) and delirium in ICU. Further studies are needed to better understand the role of ICU SCD promotion interventions in delirium mitigation.

  • Critical Care

https://doi.org/10.1136/thorax-2023-220036

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    Footnotes

    • X @KnauertMKnauert

    • Contributors EW and MPK conceived the presented idea. EW, BC and MD contributed to data extraction. EW wrote the initial draft of the manuscript. EWE, MD, BC, LB, KJB, FMPvH, ME, EW and MPK contributed to the analysis of results and revision of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MPK is a member of Serca LLC (no conflict with this review).

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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